1 Recommendations
1.1
Olaparib is recommended, within its marketing authorisation, as an option for treating HER2-negative locally advanced or metastatic breast cancer with germline BRCA1 or BRCA2 mutations in adults who have had:
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an anthracycline and a taxane as neoadjuvant or adjuvant treatment, or for metastatic disease, unless these are not suitable, and
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endocrine therapy if they have hormone receptor (HR)-positive breast cancer, unless this is not suitable.
Olaparib is only recommended if the company provides it according to the commercial arrangement.
1.2
If people with the condition and their healthcare professional, after discussing the advantages and disadvantages of all the options, consider olaparib to be 1 of a range of suitable treatments, the lowest cost option should be used. Administration costs, dosages, price per dose and commercial arrangements should all be taken into account.
Why these recommendations were made
HER2-negative, locally advanced or metastatic breast cancer with germline BRCA1 or BRCA2 mutations is usually treated with an anthracycline and a taxane (chemotherapy). If the breast cancer is also HR positive, endocrine therapy with chemotherapy may also be used. Usual treatment after chemotherapy, and endocrine therapy if appropriate, is more chemotherapy or talazoparib.
Clinical trial evidence shows that people who have olaparib have longer before their cancer gets worse than people who have chemotherapy. Olaparib has not been directly compared with talazoparib in a clinical trial. But an indirect comparison suggests that it is likely to work as well as talazoparib.
A cost comparison suggests olaparib has similar or lower costs than talazoparib when all relevant costs are taken into account including commercial agreements (see section 2). So olaparib is recommended.
For all evidence see the committee papers. For more information on NICE's evaluation of talazoparib, see the committee discussion section in NICE's technology appraisal guidance on talazoparib for treating HER2-negative advanced breast cancer with germline BRCA mutations.
Talazoparib is recommended for use after an anthracycline or a taxane, or both, which is a wider population than the licensed population for olaparib. A cost comparison of olaparib with talazoparib was suitable for this evaluation. This is because most people with the condition will have both an anthracycline and a taxane in line with NICE's guideline on early and locally advanced breast cancer. Clinical advice noted there is unlikely to be a difference in response to olaparib or talazoparib after previous treatment with an anthracycline or a taxane, or both.